To appear in The Journal of Scandinavian Public Health
Measuring subjective well-being for policy purposes: The example of well-being indicators in the WHO “Health 2020” framework
Mari Hagtvedt Vik1
Norwegian Directorate of Health
Erik Carlquist University of Oslo
1 Corresponding author contact details: Norwegian Directorate of Health, Department of Public Health and Living Conditions, P.O. Box 7000 St. Olavs plass, 0130 Oslo, Norway. Email: [email protected].
Abstract
Aims: This article discusses the rationale for measuring national well-being, and examines the use of subjectively oriented well-being measures in the context of public policy.
Recent years have witnessed growing attention towards the concept and measurement of well- being, both within academic disciplines, intergovernmental organizations such as the World Health Organization (WHO), as well as in many governments across Europe including the Nordic countries. Economic indicators have commonly been regarded as proxies of societal progress of nations, but indicators of well-being have increasingly been applied in order to complement or replace these measures.
Methods: Well-being indicators of the WHO “Health 2020” framework are critically examined with particular attention toward subjective aspects of well-being. Literature discussing the rationale for subjective indicators is reviewed. As a background, central theoretical and measurement perspectives on well-being are outlined, including hedonic, eudaimonic and objective list approaches.
Results: The WHO refers to well-being in definitions of health and mental health, but has primarily reported on disease. The “Health 2020” framework marked a shift in this concern. One of the main targets of “Health 2020” concerns well-being, involving six core indicators. Only one indicator refers to well-being as subjective experience. Literature
supports more extensive use of subjective indicators in combination with objective measures.
Conclusions: Although consensus on definitions and instruments is lacking, subjective and objective measures of national well-being may jointly contribute to a more
comprehensive understanding of societal progress, as well as a broader conception of health.
Further research is required particularly with regard to eudaimonic indicators.
Introduction
Most national governments define and measure societal progress in terms of economic indicators such as Gross Domestic Product (GDP). However, during recent decades,
governments have been increasingly interested in monitoring well-being among citizens 1, 2. In this article we will examine the indicators chosen to assess well-being in the “Health 2020”
WHO European policy framework 3, and discuss more generally how subjectively oriented measures of well-being can contribute to policymaking.
In the early history of industrialized countries, when basic human needs for food, shelter and clothes were not yet sufficiently met, improving economic conditions in order to enhance quality of life was clearly a primary concern 4, 5. Following the Second World War, confidence in the ability of economic growth to solve a wide range of problems increased 6. As a result, GDP and other macroeconomic indicators were assigned key roles, also in the Nordic countries. Economic measures represented overarching policy goals and were assumed to directly reflect the well-being of citizens. Limited attention was paid to monitoring
subjectively experienced well-being and mental health for policy purposes.
During the 1960s, when drawbacks and limitations of economic growth became more evident, a search for alternative policy goals and indicators of societal progress was initiated, known as “the social indicators movement” 6. In an often-cited speech in 1968, U. S.
presidential candidate Robert F. Kennedy addressed these limitations as a main concern for public policy. The speech concluded that: “The Gross National Product (…) measures everything in short, except that which makes life worthwhile” 7(para. 22). Originating from a 1974 study, the Easterlin paradox (also named the happiness-income paradox) clearly
emphasized that there is more to human happiness or well-being than wealth 8. Empirical data showed that over time, average happiness had not increased in accordance with rising national income in a number of countries9. Lately, nuances of the Easterlin paradox have been
challenged 10, in part related to the effect of social inequalities 11. Nevertheless, it is now generally recognized that financial prosperity is an inexact proxy of well-being, particularly in industrialized countries 4.
Recent years have seen a growing interest for using measures of well-being to complement or replace economic measures 1. This trend is evident in research as well as among intergovernmental organizations such as the Organization for Economic Co-operation and Development (OECD), the United Nations (UN), and the World Health Organization (WHO). Several new measurement instruments have been suggested, aiming to either adjust GDP, complement it, or replace it altogether. Examples include the Human Development Index (HDI), the Better Life Index, and the Happy Planet Index 12, 13.
Similarly, national policies have increasingly emphasized the importance of well- being measures. Examples include the United Kingdom’s “Measuring National Well-Being Programme” 14 and the recommendations developed by the French Commission on the Measurement of Economic Performance and Social Progress (the “Stiglitz report”) 15. During recent years, the Nordic countries have also seen initiatives to measure national well-being.
However, the countries differ regarding the extent to which they have conducted national well-being surveys as well as how well-being is comprehended and measured.
In light of these developments, considering the conceptual background of well-being measures is useful - what exactly is well-being? How should well-being be defined and operationalized in the public policy context? We now turn to central theoretical perspectives on well-being, including hedonic and eudaimonic approaches and objective list theories.
Theoretical perspectives on well-being
The complex question of what constitutes a good life, or what a life well-lived amounts to, has intrigued human beings at all times. Indeed, it is one of the ancient, yet still controversial
questions in philosophy 16, 17. The academic interest in well-being is growing, and shared by many disciplines beside philosophy, including psychology, sociology, and economics 18-20. This paper focuses mainly on the subjective aspects of well-being, drawing particularly on theoretical accounts of well-being as found in psychology. In this discipline, researchers have primarily investigated well-being from two distinctive philosophical positions: the hedonic and the eudaimonic 21-23. However, well-being in a psychological sense is closely related to the contexts in which people live their lives. Therefore, we will additionally describe a tradition emphasizing objective circumstances as important constituents of well-being.
The Hedonic Perspective
The hedonic view holds that what is good for a person is the presence of pleasure and the absence of pain 24. It stems from a conceptualization of happiness offered by Aristippus of Cyrene in the fourth century B.C. 22, and corresponds to the “greatest happiness principle” as developed in utilitarianism 25. In contemporary psychology, the hedonic view is often
conceptualized as subjective well-being (SWB), which is taken to consist of two main components – an affective component and an evaluative or cognitive component. The
affective component is typically associated with the amount of positive emotions experienced by a person, or the balance between positive and negative emotions. The cognitive component consists of evaluative judgments of how one’s life is going, usually in terms of life
satisfaction 26, 27.
The Eudaimonic Perspective
The eudaimonic perspective of well-being stems from Aristotle’s concept of eudaimonia 28, 29. According to the Aristotelian tradition, eudaimonia refers to functioning well in life, rather than positive feelings or evaluations of satisfaction 28, 30. Living well entails a striving towards
realizing one’s highest human potential, as well as committing to activities that are purposive, and in accordance with virtue 21.
The study of eudaimonia in psychology has encompassed several different constructs and a multiplicity of conceptual and operational definitions 21, 28, 31. Engagement in
meaningful endeavors, actualization of potentials and being fully functional are all
characteristics often used to describe eudaimonia 28. Some accounts further emphasize that through fulfilling one’s potential within the community, individuals can contribute to the welfare of others 32. A frequently cited model 33 suggests that eudaimonia consists of six dimensions: self-acceptance, positive relationships with others, personal growth, purpose in life, environmental mastery and autonomy. In a similar vein, self-determination theory views eudaimonic living as characterized by pursuing intrinsic goals and values, being mindfully self-regulated and behaving in ways that satisfy basic psychological needs for autonomy, relatedness and competence 28.
Questions have been raised about the fruitfulness of drawing a sharp line between the examination of hedonic versus eudaimonic well-being 34. Evidence suggests that well-being, understood as a psychological phenomenon, is better viewed as a multidimensional construct that consists of both hedonic and eudaimonic aspects 22. Several integrated frameworks have been developed during the recent years, including models of human flourishing 30, 35, 36. One such model conceptualizes flourishing as composed of three dimensions, named emotional, psychological and social well-being 30. This integrative model encompasses both affect and satisfaction as well as positive functioning and evaluations of the wider social context.
Objective List Theories
Objective list theories of well-being are constituted by sets of elements that are considered to have objective value for persons, independently of whether those elements are seen as
satisfying or desired by the individual 23. One such theory is known as the capabilities approach. Here, a person’s life is understood in light of capabilities, which refer to the actual (objectively existing) opportunities the person enjoys to achieve what he or she wants to do or be 37, 38. In other words, capabilities refer to the freedom to choose between different ways of life. While the capability approach is often presented as an overarching framework,
Nussbaum 39, 40 has suggested specific components for a list of capabilities, encompassing life, bodily health and integrity, sense/imagination/thought, emotions, practical reason, affiliation, living in relation with other species, play, and control over one’s environment.
Again, the boundary lines between the traditions are not absolute. Eudaimonic components, although typically viewed by psychologists as subjective phenomena, can also be understood as objective elements. Phenomena such as mastery, relatedness or autonomy can be comprehended either as subjective experiences or as objectively existing features of a person.
Measuring well-being
Hedonic and eudaimonic well-being
The affective component of hedonic well-being is commonly assessed by experience sampling data or surveys of the extent to which people experience positive and negative emotions. The cognitive component is typically measured by surveys of self-rated judgments of satisfaction 26. The eudaimonic approach to well-being has been empirically studied for a shorter period of time and less extensively investigated compared to the hedonic approach 20,
29. Furthermore, the diversity of conceptual definitions applied to eudaimonia is greater than to hedonia 21, 28. Consequently, there is less consensus regarding measurement of eudaimonic
well-being than for hedonic well-being 20, although a number of eudaimonic questionnaire instruments have been developed 41.
In general, it has become more legitimate to investigate subjective states in order to measure well-being in both psychology and other social sciences such as economics. This development is in part enabled by the reported psychometric robustness of modern measures, particularly within the hedonic tradition 42.
Social indicators
In principle, the social indicators approach is based on the assumption that it is possible to construct an adequate list of necessary characteristics of good lives and good societies 1. Following this understanding, social indicators are reflective of objective list theories. Social indicators may concern the immediate living conditions of individuals as well as the wider societal context 43. Examples of classical social indicators include poverty, unemployment, life expectancy and length of education 44. Social indicators are also known as key national indicators or quality of life indicators 1. It is worth noting that although the term ‘social indicators’ traditionally has referred to objective factors, it is also used to encompass subjective aspects of well-being 43-45.
The Health 2020 indicators
As is evident from the preceding discussion, the concept of well-being can be defined in rather different ways. How one decides to measure well-being will depend on how well-being is conceptualized in the first place 46. The lacking conceptual clarity is not purely an academic concern. It is reflected in public policy documents, since different countries and
intergovernmental organizations use various conceptualizations as well as operationalizations of well-being.
The World Health Organization (WHO) has placed well-being on the agenda as a marker of social progress 3, 47. The WHO views health and well-being as indispensable resources for societies and human development, contributing to economic and social stability
3. Well-being is included in the WHO definition of health, which dates back to 1948. Here, health is described “not merely as the absence of disease or infirmity” but as “physical, mental and social well-being” 47(p. 19). Mental health is an essential part of this definition.
Despite the long history of referring to well-being, WHO has primarily reported on death, disease and disability 47. However, in 2013, the European strategy “Health 2020. A European policy framework and strategy for the 21st century” (hereafter referred to as “Health 2020”) was launched. This strategy marked a shift of the WHO toward a more holistic approach to health and well-being.
“Health 2020” contains six main targets, one of them being: “Enhance the well-being of the European Region population” 3(p. 16). The strategy proposes indicators to measure the progress toward each target across the European member states. The core indicators of well- being include one subjective and five objective indicators: 1) Life satisfaction, 2) Availability of social support, 3) Percentage of population with improved sanitation facilities, 4) GINI coefficient (income distribution), 5) Unemployment rate, 6) Proportion of children of official primary school age not enrolled 48(p. 10). In addition to the six core indicators, three optional objective indicators comprise the proportion of elderly people living alone, total household consumption and educational attainment as defined by completed secondary education 48.
The WHO indicators discussed in light of theoretical perspectives on well-being The six indicators in “Health 2020” draw differentially on the theoretical perspectives
presented above. The first item concerning life satisfaction measures the cognitive component
of subjective well-being (SWB), captured by a single question on overall life satisfaction 48, as will be discussed below.
The second item pertains to social support. Positive relationships are recognized as significant to well-being by a wide range of scholars 2, 18, 28, 33, 35. However, the WHO
indicator refers to the narrower concept of social support, by asking respondents: “If you were in trouble, do you have relatives or friends you can count on to help you whenever you need them, or not?” 48 (p. 37). This indicator measures the availability of social support, rather than subjectively perceived support expressing evaluations of the quality or level of support. Thus, the WHO has classified this question as objective 48. The remaining four core indicators are clearly objective, concerning sanitation facilities, income distribution, unemployment rate, and school enrolment. The same is true for the three optional indicators. In sum, all indicators except the first one reflect the objective list tradition. It is worth noting that the WHO has described an ambition to develop additional subjective indicators reflecting either eudaimonia, affect, or satisfaction within different life domains, although data sources are yet to be
established 48(annex 1).
The only subjective measure among the existing WHO well-being indicators is the item referring to life satisfaction. Methodological and conceptual doubts have been expressed on whether a person’s satisfaction with life can be fully captured using only one single question 2. To obtain a more complete picture, life satisfaction can be measured by somewhat more comprehensive instruments such as Diener et. al.’s Satisfaction with Life Scale 26. Furthermore, it has been questioned whether measuring life satisfaction at all can provide enough information about a person’s well-being. As The New Economics Foundation (nef) has stated: “Conceptually, though, the generality of life satisfaction is a serious limitation on our ability to understand well-being” 49(p. 56). To expand the measurement of subjective well- being (as conceptualized in psychology), measures of the affective components and measures
of life satisfaction in more specific life domains could be added. From a public health point of view, which focuses on the broad determinants of health and well-being, it may be useful to expand the view of well-being even beyond traditional measures of subjective well-being (SWB) understood as affect and life satisfaction. Ryan et al. have highlighted the
consequences for health assessments and policymaking of using either hedonic or eudaimonic indicators, stating that “the kind of good life we are targeting makes a difference” 28(p. 142). According to some authors, hedonic outcomes may be less suitable as goals for policy since they are so variously produced and tied to individualistic values 28.
To take on a broader comprehension of well-being as subjective experience, one may therefore consider the contributions of the eudaimonic perspective, which emphasizes good functioning rather than good feelings 31. The many aspects of positive functioning related to issues such as meaning, relatedness, actualizations of potentials, autonomy and self-
acceptance, contribute to a broader understanding of well-being that may be helpful when developing policies. For example, policies can promote structures that allow people to feel psychological freedom and strong relationships with others 28. Eudaimonic indicators capture important elements of mental health and are of clear relevance viewed from a public health perspective. Of note, the WHO has defined mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his
community” 50(p. XVIII). This definition clearly points towards functioning and thus corresponds to a eudaimonic outlook.
With the possible exception of the social support item, no subjective eudaimonic aspects are encompassed by the WHO core indicators. The eudaimonic approach is generally less frequently reflected in national and international surveys, as compared to the hedonic perspective. However, some recent initiatives, including the OECD’s “Better Life index” and
the measures of national well-being by the Office for National Statistics (ONS) in the UK have introduced eudaimonic components, such as measures of meaningfulness and purpose and a measure of how worthwhile the things people do are perceived, respectively 51. It is possible that the lacking consensus on conceptions and measurements of eudaimonic well- being is partly to blame for the current scarcity of eudaimonic elements in national and international well-being surveys (e.g., 21, 34). The hedonic approach benefits from a longer research history, resulting in more agreement on concepts as well as measurement methods 29.
Whether the more holistic ambition in the “Health 2020” strategy is sufficiently reflected by the current set of indicators can be questioned. However, the WHO aims to develop a comprehensive conceptualization as well as more multidimensional measures of well-being, including eudaimonic elements 3, 47, 48. The current choice of indicators in “Health 2020” is pragmatic, building on the statistics and measures available to the member states at this point of time.
Subjective indicators in a public policy context
It is commonly assumed that an important purpose of public policymaking is to enable good lives and enhance the well-being of citizens 42. WHO has argued that “Improving – or at least maintaining – well-being is part of the social contract between the governments and the people they represent” 47(p. 20). As we have presented in the previous sections, well-being can be seen to exist in both subjective and objective forms. What roles can subjective indicators play in measuring national well-being? Several arguments supporting the use of subjective measures for this purpose have been put forth, including proposals of how and when such indicators can be useful to policymaking.
First, a general rationale for using subjective indicators can be derived from the so- called Thomas theorem: “If men [sic] define situations as real, they are real in their
consequences” 45(p. 4). Humans do not act mechanically in response to an objectively existing social world, but rather according to their subjective interpretation of it. Objective indicators alone therefore cannot sufficiently cover the diverse concept of well-being 43, 45. In order to understand human action it is fundamental to gain knowledge about subjective interpretations, most straightforwardly by asking people directly about their emotions, perceptions and
evaluations 43. A similar view has been expressed by Campbell and Converse 52(p. 442):
“Ultimately, the quality of life must be in the eye of the beholder.” see also 45.
Second, it has been argued that subjective indicators can give policy makers valuable information about public preferences and give citizens a voice 43. Such information can be useful for guiding the selection of policy goals 53, as well as weighting different objective indicators against each other in terms of their relative importance 1. Furthermore, both broader and narrower subjective measures may be applied. For example, a general measure of life satisfaction can be useful for policy questions concerning inequality because large satisfaction discrepancies 54 between social classes might increase the risk of social instability. Narrower measures, for example relating to the well-being of workers at various ages can provide more specific information that can guide the choice between policy alternatives in these areas 5.
Third, evidence suggests that different forms of subjectively experienced well-being can predict positive outcomes for individuals as well as societies 5. For example, subjective well-being can influence objective outcomes such as health and job success 42, 55. The existence of causal paths from subjective well-being to objective outcomes is empirically supported by longitudinal and experimental studies. Individuals high in well-being tend to perform better at work and have better social relationships 4. People experiencing lasting positive emotions have a higher tendency of trusting others in their community and being involved in volunteer work 5. Studies further indicate that high subjective well-being can cause better health and longevity 56. Similarly, evidence has illustrated how eudaimonic well-
being can promote length of life and reduce risk of disease 57. It has also been suggested that people characterized by high eudaimonic well-being tend to behave more prosocially, thus benefiting society in addition to themselves 28.
Finally, subjective indicators are valuable not only in their own right or as predictors, but also because they can be interpreted in combination with objective measures. A typology of four “welfare positions” 45, has proved useful to shed light on the contribution of subjective indicators. This model cross-tabulates objective living conditions (good or bad) with
subjective well-being (good or bad), resulting in the categories “well-being” (good objective conditions as well as good subjective well-being), “dissonance” (good objective conditions, but bad subjective well-being), “adaptation” (bad objective conditions, but good subjective well-being), and “deprivation” (bad objective conditions and bad subjective conditions) see also
43, 58. The two categories “adaptation” and “dissonance” are particularly interesting from a measurement perspective, since the assessments based on objective and subjective
information diverge. By illustrating how subjective and objective indicators provide different information for capturing the well-being of individuals, this typology highlights the need for using both kinds of measures.
Relatedly, Dolan and White 42 have argued that the distribution of subjective well- being across society should be analyzed together with objective well-being indicators. In this way, it is possible to identify how subjective and objective well-being levels correspond or diverge. By a similar token, Barstad 44 has emphasized the importance of considering the components of well-being in a holistic way. Regarding policies aiming to reduce social inequality, such investigation may be important since disadvantageous objective
circumstances tend to accumulate in certain groups. It is an empirical question whether such accumulation is associated with reduced subjective well-being. The development of fits or discrepancies between subjective and objective well-being levels can be systematically
studied across time, and thereby contribute to a richer understanding of well-being in changing societies.
Studies of the associations between objective circumstances and subjective well-being have largely made use of the hedonic perspective, primarily measuring affect and satisfaction levels. The association between eudaimonic well-being and objective circumstances is little investigated and deserves further attention 44.
Despite numerous arguments for the usefulness of subjective indicators, there are also qualms about the role of these measures in guiding policy 42, 43, 45, 53. Among the criticisms are not only claims of measurement problems, but also doubts concerning whether maximising well-being, subjectively understood, should be an aim for governments. Questions have also been raised about governments’ actual abilities to raise the experienced well-being of citizens
14, 53. The existence of adaptation processes is one of the most critical problems faced by policy makers in this regard 45, 59. Adaptation processes refer to the inclinations for persons to habituate to changes in objective circumstances such as living conditions, income and health
42. Such adaptation processes can occur in a downward as well as upward fashion. The downward and upward adaptation processes correspond to the previously mentioned welfare positions named “adaptation” and “dissonance” respectively 45. The fact that subjective assessments and objective conditions can diverge, and furthermore that subjective reports might depend on comparisons and aspirations, have led some scholars to conclude that
subjective indicators are not credible and useful for policymaking cf. 6, 43. However, it has been explicitly argued that these divergences and “biases” are strengths rather than shortcomings, adding additional insights to what is already known from objective indicators 43.
In general, despite the disagreements on conceptualizations as well as measurement methods, there is increasing support in the literature for the claim that well-being is a
multidimensional concept that should be assessed using both subjective and objective measures 2, 4, 15.
Conclusion
The present article has illustrated how well-being is not a clearly defined concept, and that several ways to measure well-being exist 16. Despite lacking consensus on definitions and instruments, measures of national well-being can contribute to a more comprehensive understanding of societal progress and welfare, as well as a broader conception of health.
The systematic and comprehensive measurement of subjective and objective well-being has the potential to constructively guide policy choices. As Stiglitz has stated; “what you measure affects what you do” 60(p. 72).Further cross-disciplinary research on well-being concepts and measurements and the use of well-being indicators in policymaking contexts are likely to bring new insights to the field. More research on eudaimonic indicators is required. Both the OECD and the WHO, as expressed in the “Health 2020” strategy, have underscored the importance of further developing eudaimonic measures. Moreover, research efforts should include the joint analysis of subjective and objective indicators.
References
1. Diener E, Lucas RE, Schimmack U and Helliwell JF. Well-being for public policy. New York:
Oxford University Press, 2009.
2. Forgeard MJC, Jayawickreme E, Kern ML and Seligman MEP. Doing the right thing: Measuring wellbeing for public policy. International Journal of Wellbeing. 2011; 1: 79-106.
3. WHO. Health 2020: A European policy framework and strategy for the 21st century.
Copenhagen: World Health Organization Regional Office for Europe, 2013.
4. Diener E and Seligman MEP. Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest. 2004; 5: 1-31.
5. Diener E and Tov W. National accounts of well-being. In: Land KC, Michalos AC and Sirgy MJ, (eds.). Handbook of social indicators and quality of life research. Dordrecht: Springer
Science+Business Media, 2012, p. 137-57.
6. Moum T and Wiese RV. Subjektivt velvære som velferdsindikator og velferdsmål [Subjective well-being as an indicator and a measure of welfare]. Tidsskrift for velferdsforskning. 2011; 14:
138-49.
7. Kennedy RF. Robert F. Kennedy speeches. Remarks at the University of Kansas, March 18, 1968. Taken from a transcript at the John F. Kennedy Presidental Library & Museum. 1968.
8. Easterlin RA. Does economic growth improve the human lot? Some empirical evidence. In:
David PA and Reder MW, (eds.). Nations and households in economic growth: Essays in honor of Moses Abramovitz. New York: Academic Press, 1974, p. 89-125.
9. Easterlin RA, McVey LA, Switek M, Sawangfa O and Zweig JS. The happiness–income paradox revisited. Proceedings of the National Academy of Sciences. 2010; 107: 22463-8.
10. Senik C. Wealth and happiness. Oxford Review of Economic Policy. 2014; 30: 92-108.
11. Oishi S and Kesebir S. Income inequality explains why economic growth does not always translate to an increase in happiness. Psychological Science. 2015; 26: 1630-8.
12. Delhey J and Kroll C. A “happiness test” for the new measures of national well-being: How much better than GDP are they? In: Brockmann H and Delhey J, (eds.). Human happiness and the pursuit of maximization. Springer Netherlands, 2013, p. 191-210.
13. Taylor TE. Towards consensus on well-being. In: Søraker JH, Van der Rijt J-W, de Boer J, Wong P-H and Brey P, (eds.). Well-being in contemporary society. Springer International Publishing, 2015, p. 1-16.
14. Lelkes O. Minimising misery: A new strategy for public policies Instead of maximising happiness? Social Indicators Research. 2013; 114: 121-37.
15. Stiglitz JE, Sen A and Fitoussi J-P. Report by the Commission on the measurement of economic performance and social progress. Paris: Centre de recherche en économie de Sciences Po, 2009.
16. Alexandrova A. Well-being and philosophy of science. Philosophy Compass. 2015; 10: 219-31.
17. Brülde B. Happiness and the good life. Introduction and conceptual framework. Journal of Happiness Studies. 2007; 8: 1-14.
18. Delle Fave A, Brdar I, Wissing MP, et al. Lay definitions of happiness across nations: The primacy of inner harmony and relational connectedness. Frontiers in Psychology. 2016; 7.
19. Duncan G. What do we mean by «happiness»? The relevance of subjective well-being to social policy. Social Policy Journal of New Zealand. 2005; 25: 16-31.
20. Linley PA, Maltby J, Wood AM, Osborne G and Hurling R. Measuring happiness: The higher order factor structure of subjective and psychological well-being measures. Personality and Individual Differences. 2009; 47: 878-84.
21. Huta V and Waterman AS. Eudaimonia and its distinction from hedonia: Developing a
classification and terminology for understanding conceptual and operational definitions. Journal of Happiness Studies. 2014; 15: 1425-56.
22. Ryan RM and Deci EL. On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology. 2001; 52: 141-66.
23. Tiberius V. Recipes for a good life: Eudaimonism and the contribution of philopsophy. In:
Waterman AS, (ed.). The best within us: Positive psychology perspectives on eudaimonia.
Washington: American Psychological Association, 2013, p. 19-38.
24. Kahneman D, Diener E and Schwartz N. Well-being: The foundations of hedonic psychology.
New York: Russell Sage, 1999.
25. Mill JS. Utilitarianism. London: Longman, 1864.
26. Diener E. Assessing subjective well-being: Progress and opportunities. Social Indicators Research. 1994; 31: 103-57.
27. Tay L, Chan D and Diener E. The metrics of societal happiness. Social Indicators Research.
2014; 117: 577-600.
28. Ryan RM, Huta V and Deci EL. Living well: A self-determination theory perspective on eudaimonia. Journal of Happiness Studies. 2008; 9: 139-70.
29. Waterman AS. Reconsidering happiness: A eudaimonist's perspective. The Journal of Positive Psychology. 2008; 3: 234-52.
30. Keyes CLM and Simoes EJ. To flourish or not: Positive mental health and all-cause mortality.
American Journal of Public Health. 2012; 102: 2164-72.
31. Vittersø J. The most important idea in the world: An introduction. In: Vittersø J, (ed.). Handbook of Eudaimonic Well-Being. Cham: Springer International Publishing, 2016, p. 1-24.
32. Peterson C, Park N and Seligman MEP. Orientations to happiness and life satisfaction: the full life versus the empty life. Journal of Happiness Studies. 2005; 6: 25-41.
33. Ryff CD and Singer B. Know thyself and become what you are: A eudaimonic approach to psychological well-being. Journal of Happiness Studies. 2008; 9: 13-39.
34. Kashdan TB, Biswas-Diener R and King LA. Reconsidering happiness: The costs of
distinguishing between hedonics and eudaimonia. The Journal of Positive Psychology. 2008; 3:
219-33.
35. Keyes CLM. The Mental Health Continuum: From languishing to flourishing in life. Journal of Health and Social Behavior. 2002; 43: 207-22.
36. Seligman MEP. Flourish: A visionary new understanding of happiness and well-being. New York: Free Press, 2011.
37. Sen A. Human rights and capabilities. Journal of Human Development. 2005; 6: 151-66.
38. Robeyns I. The capability approach: A theoretical survey. Journal of Human Development. 2005;
6: 93-117.
39. Nussbaum M. Women and human development: The capabilities approach. Cambridge:
Cambridge University Press, 2000.
40. Nussbaum M. Creating capabilities. Cambridge: Belknap / Harvard University Press, 2011.
41. Proctor C and Tweed R. Measuring eudaimonic well-being. In: Vittersø J, (ed.). Handbook of Eudaimonic Well-Being. Cham: Springer International Publishing, 2016, p. 277-94.
42. Dolan P and White MP. How can measures of subjective well-being be used to inform public policy? Perspectives on Psychological Science. 2007; 2: 71-85.
43. Kroll C and Delhey J. A happy nation? Opportunities and challenges of using subjective indicators in policymaking. Social Indicators Research. 2013; 114: 13-28.
44. Barstad A. Levekår og livskvalitet: Vitenskapen om hvordan vi har det [Living conditions and quality of life: The science of how we are doing]. Oslo: Cappelen Damm akademisk, 2014.
45. Noll H-H. Subjective social indicators: Benefits and limitations for policy making—An introduction to this special issue. Social Indicators Research. 2013; 114: 1-11.
46. van der Deijl W. Are measures of well-being philosophically adequate? Philosophy of the Social Sciences. 2017: Advance online publication.
47. WHO. The European health report 2012: Charting the way to well-being. Copenhagen: World Health Organization Regional Office for Europe, 2013.
48. WHO. Targets and indicators for Health 2020. Version 3. Copenhagen: World Health Organization Regional Office for Europe, 2016.
49. Michaelson J, Abdallah S, Steuer N, Thompson S and Marks N. National accounts of well-being:
Bringing real wealth onto the balance sheet. London: new economics foundation, 2009.
50. WHO. Promoting mental health: Concepts - emerging evidence - practice. Geneva: World Health Organization, 2005
51. OECD. Guidelines on measuring subjective well‑being. OECD Publishing, 2013.
52. Campbell A and Converse PB. The human meaning of social change. New York: Russell Sage Foundation, 1972.
53. Veenhoven R. Why social policy needs subjective indicators. Social Indicators Research. 2002;
58: 33-46.
54. Abdallah, S, Wheatley, H and Quick, A. Measuring wellbeing inequality in Britain. 2017 [cited 2017 Jun 12]. Available from:
https://whatworkswellbeing.files.wordpress.com/2017/03/measuring-wellbeing-inequalities-in- britain-march2017.pdf
55. Diener E and Tay L. New frontiers: Societal measures of subjective well-being for input to policy. In: Bruni L and Porta PL, (eds.). Handbook of research methods and applications in happiness and quality of life. Cheltenham: Edward Elgar Publishing, 2016, p. 35-52.
56. Diener E and Chan MY. Happy people live longer: Subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-Being. 2011; 3: 1-43.
57. Ryff CD. Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics. 2014; 83: 10-28.
58. Michalos AC and Robinson SR. The good life: Eighth century to third century BCE. In: Land KC, Michalos AC and Sirgy MJ, (eds.). Handbook of Social Indicators and Quality of Life Research. Dordrecht: Springer Netherlands, 2012, p. 23-61.
59. Austin A. On well-being and public policy: Are we capable of questioning the hegemony of happiness? Social Indicators Research. 2016; 127: 123-38.
60. Stiglitz JE. The measurement of wealth: Recessions, sustainability and inequality. In: Stiglitz JE and Guzman M, (eds.). Contemporary issues in macroeconomics: Lessons from the crisis and beyond. London: Palgrave Macmillan UK, 2016, p. 63-76.
Acknowledgements
The authors wish to thank Norwegian Directorate of Health for contributing to making this work possible. We are also grateful to Antonella Delle Fave for helpful comments on an early draft of this paper. Any opinions and/or conclusions expressed in the article are those of the authors alone, and do not necessarily reflect the views of the institutions they represent.
